Healthcare Provider Details

I. General information

NPI: 1255944708
Provider Name (Legal Business Name): ORTHO SPORTS PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11205 S DIXIE HWY STE 101
PINECREST FL
33156-4447
US

IV. Provider business mailing address

7180 E LAGO DR
CORAL GABLES FL
33143-6512
US

V. Phone/Fax

Practice location:
  • Phone: 786-223-7410
  • Fax:
Mailing address:
  • Phone: 786-223-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BEATRIZ SAGARDUY SUSTACHA
Title or Position: CO-OWNER/STAFF PHYSICAL THERAPIST
Credential: DPT
Phone: 786-223-7410